摘要目的 探讨肠腔分流并选择性冠状血管缝扎术对成人门静脉海绵样变性的治疗作用及临床价值.方法 对郑州大学第一附属医院收治的28例成人门静脉海绵样变性并行肠腔分流、脾动脉结扎、选择性冠状静脉缝扎术治疗患者的临床资料结合国内外资料进行回顾性分析.采用SPSS17.0统计软件对数据进行分析,两样本均数的比较采用t检验.结果 本组无手术死亡病例,分流后自由门静脉压力平均下降9.8 cm H2O(1 cm H2O=0.098 kPa),术后并发轻微肝性脑病2例,乳糜漏3例,应激性溃疡出血1例,均通过非手术治疗后痊愈.26例得到随访,血氨正常,人工血管均通畅.2例再发出血,1例行脾切断流术,1例行改良脾肺固定术.结论 肠腔分流并选择性血管缝扎术对成人门静脉海绵样变性是安全有效合理的手术方式.

abstractsObjective To investigate the clinical effect of mesocaval shunt combined with selective vascular ligation for portal hypertension caused by cavernous transformation of the portal vein in adults.Methods The clinical data of 28 adult patients with portal hypertension caused by cavernous transformation of the portal vein treated by mesocaval shunt plus splenic artery combined with coronary vein ligation were retrospectively analyzed.SPSS17.0 statistical software was used for data analysis,two sample t test was used for comparing.Results There was no operative death case,free portal pressure after shunt decreased 9.8 cm H2O( 1 cm H2O =0.098 kPa),postoperative complications included slight hepatic encephalopathy in 2 cases,chylous leakage in 3 cases,stress ulcer bleeding in 1 case,which were cured by conservative treatment.Twenty-six cases were followed up,normal blood ammonia,artificial blood vessels were unobstructed.Rebleeding in 2 cases,1 case was performed with splenopneumopexy,1 case was performed with splenectomy plus pericardial devascularization.Conclusions Mesocaval shunt combined with selective vascular ligation for portal hypertension caused by cavemous transformation of the portal vein in adults is a safe and effective operative method.